title: Neonatal zinc supplementation for prevention of mortality and morbidity in breastfed low birth weight infants: systematic review of randomized controlled trials.
abstract: OBJECTIVE
  To evaluate whether zinc supplements prevent mortality and morbidity in breastfed low birth weight infants.
  
  
  METHODS
  All randomized or qausi-randomized trials with individual or cluster allocation and using concurrent controls were included. Study population included LBW infants irrespective of gestational status who were exclusively or predominantly breastfed at the initiation of intervention. Intervention comprised zinc salts given as tablets or syrups orally to provide at least 1 RDA of elemental zinc for at least a period of 14 days, introduced within one month of birth. Electronic databases were searched irrespective of language and publication status.
  
  
  RESULTS
  Three trials from developing countries met the inclusion criteria. Limited data did not indicate a reduced risk of mortality (1 trial, RR=1.11; 95% CI 0.57 to 2.18 at one year), hospitalization rate (1 trial, odds ratio 1.10; 95% CI 0.87 to 1.39), acute respiratory infection (1 trial), or diarrhea (2 trials). However, the trial reporting on mortality was not adequately powered for evaluating this outcome. There was no evidence of an increase in weight (3 trials) or height (2 trials) at either 6 months or one year of age, or of an increased risk of vomiting following zinc supplementation. Serum zinc levels at the end of intervention were significantly higher in the supplemented group (2 trials).
  
  
  CONCLUSIONS
  In view of no convincing evidence of benefits from the limited data available, currently there is no justification for recommending routine zinc supplementation for breastfed LBW newborns in developing countries.
authors.affiliation: Department of Pediatrics and Clinical Epidemiology, Sitaram Bhartia Institute of Science and Research, B-16 Qutab Institutional Area, New Delhi, India.
authors.forename: Anjana
authors.initials: A
authors.lastname: Gulani
authors.forename: Shinjini
authors.initials: S
authors.lastname: Bhatnagar
authors.forename: H P S
authors.initials: HP
authors.lastname: Sachdev
mesh_terms: D001942:Breast Feeding; D006801:Humans; D007226:Infant Mortality; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D016032:Randomized Controlled Trials as Topic; D015032:Zinc / Q000627:therapeutic use*
chemical_list: D015032:Zinc